Navigating Disability Claims Management with Independent Medical Examinations

May 29, 2018

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You’ve got a tough disability claim on your desk. The claimant has had an accident that prevents them for working due to a disability, but some of the information just isn’t adding up. It could be that they just haven’t recorded it properly and you need to reach out to get it. But maybe the doctor’s report itself isn’t quite aligning with what you think is going on.

Without direct access to any of these people, and without medical expertise yourself, you need a helping hand. That’s where the Independent Medical Examination (IME) comes in.

What is an Independent Medical Examination?

An IME involves recruiting an independent medical expert to examine a claimant. They will use their knowledge and expertise to provide an additional opinion about the condition in question. You’ll then receive an authoritative report that you can use to aid your decision-making in case management.

When to use an Independent Medical Examination?

If you’re handling a brand new claim that you’re unsure of, that’s the perfect time to get things off on the right foot with an IME. On the other hand, if you’re looking at an ongoing claim and the issue seems to be lingering longer than expected, or if circumstances suddenly change without warning, that’s also a good time to get that second opinion assurance.

Can a claimant refuse to submit to an IME?

A claimant might have legal grounds to refuse to submit to an IME. Given the complexities of medicine and law, you may need to seek specific advice if a claimant does refuse.

On the other hand, in some jurisdictions and in some circumstances, an IME may be legally mandated after an accident, or it might be contractually obligated as part of the disability claims process. If a claimant refuses to submit to one, you may be free to deny their claim outright as the claimant is in breach of policy.

Benefits of an Independent Medical Examination for a Disability Case

Insurance policies are complicated. Injuries and illnesses can also be complicated. Relying on just the information that you’re given by the claimant and their doctor might not be enough for you to see that a claim satisfies the minutia of the policy in order to trigger a payment.

With an IME, you have the advantage of being able to select an expert with specific experience to examine the condition. You’ll get the information that you need in order to make the right decision.

How to find an appropriate medical expert

Western Medical Assessments has decades of experience with IMEs. We work with a network of experienced specialists in all fields, and we’re well positioned to help connect case managers with practitioners you can trust.

Reach out to us today, and we’ll help you get started with the help you need to resolve your difficult claims. If you’d like to read more, you may find our post on disability claims and mental illnesses useful.

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